Beyond motor symptoms, Parkinson’s disease (PD) patients also experience fluctuations in non-motor symptoms with oral dopaminergic medication intake. During On states, dopaminergic medication is working optimally, whereas during Off states dopaminergic functioning is limited, leading to worse symptom severity. However, little is known about how these fluctuations relate to social functioning in daily life. The present study examined whether depressive symptoms and medication states were associated with the likelihood of engaging socially and perceived social effort in daily life using an Ecological Momentary Assessment (EMA) study design. 

Thirty-four PD patients completed a baseline depression questionnaire and a 14-day EMA protocol, reporting social interactions and perceived social effort five times daily via a smartphone. Perceived social effort was significantly higher in Off and Transition states compared to On states and was also associated with higher depression scores. In contrast, the likelihood of having a social interaction was not associated with depression scores or medication states. Depression did not moderate the association between medication states and social functioning. 

These findings suggest that depressive symptoms and medication states primarily affect the subjective experience of social engagement rather than its frequency. Perceived social effort may therefore represent a sensitive indicator of social burden in PD. Clinicians could benefit from assessing not only interaction frequency, but also perceived social effort, to better capture the social impact of PD-related symptom fluctuations.